Current opinion in rheumatology最新文献

Purpose of review: Autoimmune and inflammatory rheumatic diseases as well as certain musculoskeletal diseases treated by rheumatologists result from a complex interplay between genetic predisposition and environmental factors.

Recent findings: Accumulating research has examined the possible roles of physical trauma, psychological stress, pollutants, and occupational exposures as triggers or influencers of disease. We review and summarize existing evidence for these contributors for conditions including rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, spondyloarthritis, systemic sclerosis, Sjogren's syndrome, vasculitis, myositis and fibromyalgia. We highlight findings from case-control, cohort, and twin studies that associate trauma, chronic stress and environmental exposure with immune dysregulation and increased disease risk. We apply the GRADE framework to assess the strength of evidence and identify key research gaps. Summary tables are included to guide clinical assessment which could also support interdisciplinary communication in medico-legal contexts.

Summary: These data have implications for disease etiopathogenesis; management; historical appreciation; public health, policy and safety; and legal considerations.

Purpose of review: Here, we provide a broad overview of the current treatment landscape of neuropsychiatric systemic lupus erythematosus (NPSLE) focusing on diffuse central nervous system manifestations and potential new treatments based on studies of murine models and neuroimaging studies of patients.

Recent findings: The therapeutic landscape focuses on three approaches: modulation of B cell activity and circulating autoantibodies (CAR-T cell and BTK inhibitor therapies), reduction of systemic inflammation (JAK, TYK2, and anti-IFN inhibitors), and direct neuroprotection (ACE inhibitors and ARBs).

Summary: These findings broaden the therapeutic landscape for NPSLE beyond general immunosuppression. Future research must prioritize clinical trials inclusive of NPSLE patients to validate these promising strategies.

Purpose of review: This review examines recent advancements in spatial transcriptomics and its current and potential use to advance musculoskeletal (MSK) research. These insights will be vital to address the complexity of MSK diseases and will pave the way for future therapeutic developments.

Recent findings: The advent of next-generation sequencing has significantly improved our understanding of the cellular and transcriptomic heterogeneity in the MSK system. Spatial transcriptomics has revolutionized research allowing in-situ gene expression analyses directly from intact histological sections. Understanding spatial transcriptomes of cells within tissues will shed light into the biological complexity of MSK diseases. Here, we summarize the role of spatial transcriptomics in unveiling molecular mechanisms underlying MSK diseases and the challenges prohibiting its widespread application in MSK research, and opportunities to overcome these challenges.

Summary: We provide a summary of emerging techniques in spatial transcriptomic field and its use in advancing MSK research. Furthermore, challenges in its application in MSK tissues are discussed as well as potential future considerations to improve spatial transcriptomics insights.

Purpose of review: This review aims to explore the relationship between autoinflammatory diseases (AIDs) and vasculitis, with a focus on recently identified syndromes and newly published data since 2016.

Recent findings: While the connection between innate immune dysregulation and systemic inflammation is well established in AIDs, the occurrence of vasculitis in these disorders remains underrecognized and often misclassified.We discuss vasculitic manifestations in a wide range of AIDs, including familial Mediterranean fever, DADA2, HA20, VEXAS, CAPS, TRAPS, HIDS/MKD, Blau syndrome, and others. Each condition presents a unique pattern of vascular involvement, ranging from incidental cutaneous findings to life-threatening systemic vasculitis. The underlying mechanisms often involve overactivation of inflammatory pathways such as IL-1β, or NF-κB, and in some cases, novel genetic mutations affecting non-inflammatory pathways such as purine metabolism. The histologic, clinical, and genetic features often differ from classic vasculitic syndromes.

Summary: Recognizing vasculitis in the context of AIDs is critical for early diagnosis, especially in pediatric patients or those with treatment-resistant or atypical presentations. Genetic testing should be considered in such cases. Understanding these distinct disease patterns allows physicians to tailor management strategies, including biologic therapies or hematopoietic stem cell transplantation, improving outcomes in these complex and often severe disorders.

Purpose of review: There is a complex relationship between nonhematological malignancies and vasculitis Paraneoplastic vasculitis may present in many different forms. Cancer risk is high in patients with some types of vasculitis. Also, immune checkpoint inhibitors (ICIs) used in treatment of many solid tumors may cause vasculitis.

Recent findings: Vasculitis associated with solid tumors is less frequently seen when compared to vasculitis associated with hematological malignancies. Cutaneous leukocytoclastic vasculitis (vasculitis of small vessels) is the most frequently encountered paraneoplastic vasculitis type. Paraneoplastic vasculitis is usually seen in patients with lung, genitourinary and gastrointestinal system tumors. The timing of paraneoplastic vasculitis varies as before, after or concurrently with the diagnosis of malignancy. Vasculitis is usually considered to be paraneoplastic when time gap between the onset of vasculitis and diagnosis of cancer is within 12 months. ICIs used frequently in treatment of many solid tumors may cause vasculitis by stimulating T cell activation. They usually cause large vessel (temporal arteritis and single organ vasculitis), central nervous system vasculitis or small vessel vasculitis.

Summary: Close monitoring of patients with vasculitis is essential for early recognition of an underlying malignancy and directing treatment options towards cancer specific treatments. Vasculitis due to ICIs should be recognized as early as possible when ICIs should be stopped, and immunosuppressives should be started to avoid severe complications of immune adverse events diagnosed to with- hold ICIs and start immunosuppressive treatments precluding severe complications of immune adverse events.

Purpose of review: This review examines the complex bidirectional relationship between vasculitis and hematologic malignancies, highlighting the importance of meticulous diagnostic assessment.

Recent findings: Vasculitis may emerge in the setting of hematologic malignancies via mechanisms such as paraneoplastic inflammation, immune dysregulation, drug exposure, and clonal hematopoiesis. Myeloid neoplasms - especially myelodysplastic syndrome (MDS) and chronic myelomonocytic leukemia (CMML) - show a stronger association than lymphoid malignancies, with cutaneous small vessel vasculitis being the most common subtype. VEXAS syndrome exemplifies the overlap between autoinflammation and hematologic disease, often presenting with vasculitic features and macrocytic anemia.In lymphoproliferative disorders and plasma cell dyscrasias, vasculitis may precede, mimic, or complicate the malignancy. Entities such as intravascular lymphoma, angioimmunoblastic T-cell lymphoma, and monoclonal gammopathies - including MGUS and multiple myeloma - can manifest with vasculitic symptoms, requiring histopathologic and molecular evaluation. Emerging concepts like monoclonal gammopathy of cutaneous and rheumatologic significance highlight the need for interdisciplinary care.Drug-induced vasculitis, particularly from immunomodulatory agents and biologics, adds diagnostic complexity. Atypical features - such as unexplained cytopenias, dual autoantibody positivity, or poor response to immunosuppression - should prompt evaluation for underlying hematologic disease. Conversely, vasculitis may signal complications in patients with known hematologic disorders.

Summary: Early suspicion of vasculitis associated with hematologic malignancies and accurate diagnosis are important in guiding therapeutic approaches.

Purpose of review: Telocytes (TCs) are unique stromal cells with distinctive morphology, ultrastructural features, and intercellular communication abilities. Accumulating evidence supports their critical roles in tissue homeostasis, regeneration, and stem cell niche maintenance through both cell-to-cell contacts and delivery of paracrine signals. The purpose of this review is to provide an up-to-date overview of the current knowledge regarding the pathophysiologic implications and therapeutic potentials of TCs in multiorgan fibrosis.

Recent findings: Loss and/or structural degeneration of TCs have been implicated in the pathogenesis of fibrotic conditions affecting the skin, gastrointestinal tract, heart, lungs, kidneys, and reproductive organs. TC depletion has often been associated with extracellular matrix remodeling, aberrant fibroblast activation, disruption of stem cell support, and altered tissue architecture. Experimental evidence suggests that TCs may possess antifibrotic therapeutic potentials, with TC transplantation or administration of TC-derived secretome/extracellular vesicles mitigating fibrosis progression in different preclinical models.

Summary: TCs are emerging as pivotal regulators of stromal homeostasis across several organs and their loss appears to be a unifying feature in the pathogenesis of tissue fibrosis in different anatomical districts. Targeting TCs, either by preserving their function or restoring their networks/paracrine signals, may open new therapeutic avenues for managing various fibrotic diseases.

Purpose of review: Sjögren disease (SjD) constitutes a diagnostic and therapeutic challenge due to its clinical heterogeneity and complex pathophysiology. This review synthesizes recent advances in diagnostics, disease stratification, and targeted therapies, highlighting their potential to optimize patient care.

Recent findings: Emerging diagnostic approaches include advanced salivary, lacrimal, and serum biomarkers, refinements of established diagnostic tools, role of specific autoantibodies, and AI-assisted histopathology, improving early detection and risk stratification, particularly for lymphoma-prone phenotypes. Novel immunological insights have enabled phenotype-based classification, guiding the development of targeted therapies against B-cell pathways, cytokines, and co-stimulatory molecules with several agents (e.g., belimumab, ianalumab, telitacicept) showing promise in reducing disease activity scores.

Summary: Recent advances provide a framework for precision medicine in SjD, integrating molecular and imaging biomarkers into patient selection and treatment monitoring. Clinically, this could enable earlier diagnosis, individualized risk assessment, and tailored therapy. Research priorities now include validating diagnostic innovations in diverse populations, elucidating phenotype-specific mechanisms, and conducting adequately powered, biomarker-driven trials to optimize therapeutic efficacy.

Purpose of review: VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome is a newly discovered, adult-onset, hemato-inflammatory disease driven by clonal dominance of pro-inflammatory hematopoietic cells bearing a somatic mutation in the UBA1 gene. This review aims to integrate and discuss the most recent insights into the evolving understanding of VEXAS pathogenesis and clinical management.

Recent findings: An interplay between inflammation and clonal dominance of UBA1 mutant hematopoietic clones underlies the pathogenesis of VEXAS syndrome. Mutant cells both generate and sustain a toxic inflammatory milieu that impairs wild-type hematopoiesis. Despite exhibiting dysfunctional differentiation, VEXAS cells activate pro-survival pathways that support their persistence and progressive dominance.Recent international guidelines offer evidence-based recommendations to optimize therapy and manage both inflammatory and hematologic features of the disease.

Summary: This review dissects the key molecular mechanisms driving inflammation and clonal survival in UBA1 mutant cells, and outlines current therapeutic strategies proposed to counteract VEXAS progression and improve patient outcomes. The recent findings presented here, along with the deeper understanding that will be built upon them, not only advance the knowledge of the disease pathobiology, but also pave the way for more precise, mechanism-driven treatment approaches aimed at intercepting disease progression and improving long-term outcomes.

Purpose of review: This review provides a timely synthesis of key findings derived from the EUSTAR (European Scleroderma Trials and Research) database, the largest international registry dedicated to systemic sclerosis (SSc), now including over 27 000 patients worldwide. As interest grows in real-world data and precision medicine in rare diseases, EUSTAR offers a uniquely rich, longitudinal dataset built over two decades of global collaboration. With sustained growth, more than 1000 new patients enrolled annually, this registry continues to inform clinical practice and research with contemporary, diverse patient data.

Recent findings: Analyses from EUSTAR have clarified disease phenotypes and trajectories, identified predictors of organ involvement and mortality, and validated outcome measures including the EUSTAR Activity Index. Studies have also revealed heterogeneity in treatment patterns, supported the refinement of classification criteria, and highlighted regional disparities in care. The registry has been a foundation for innovative research approaches such as emulated clinical trials, comparative effectiveness analyses, and external control arms for interventional studies.

Summary: EUSTAR has become a reference model for collaborative research in rare diseases. Its findings have directly informed guidelines and routine management of SSc. Future directions include integrating digital tools, artificial intelligence, and expanding the registry's role in clinical trial design and personalized medicine.